Journal of cataract and refractive surgery最新文献

Purpose: To evaluate the post occlusion surge characteristics of venturi and peristaltic-generated vacuum levels.

Setting: University setting, Salt Lake City, Utah.

Design: Experimental study.

Methods: The Johnson and Johnson Veritas machine and Ellips FX handpiece with standard pack tips, with variable peristaltic and venturi settings, were used. A standard quadrant removal preset had the settings: vacuum 450mmHg, aspiration 60mmHg, bottle heights 41 cm and 81 cm. To monitor pressure changes, a rubber disk was fixed within a sealed chamber fitted with an electric sensor. The phaco tip was inserted through a small opening; the foot pedal was set to position three. The tip was in contact with the disk to replicate tip occlusion, then pulled from the disk to simulate occlusion break. Ten trials were performed for each IOP and vacuum type.

Results: A significant difference (P < .01) was observed in post-occlusion surge magnitude between venturi and peristaltic pumps at 41 cm and 81 cm bottle heights. No significant difference was observed in surge duration at either bottle height. Average duration of surge for venturi and peristaltic at 41 cm was 1.56s ± 0.75 and 2.25s ± 0.40, respectively; at 81 cm 2.27s ± 1.41 and 2.90s ± 1.10, respectively.

Conclusions: Data suggest that at bottle heights of 41 and 81 cm, with indicated settings, venturi settings on the Veritas platform have a lower post-occlusion surge magnitude compared to peristaltic settings. This indicates that there may be a platform-specific lower risk of posterior capsular tear when using venturi settings in the Veritas system during cataract surgery.

Purpose: To compare the outcomes of spherical equivalent and residual astigmatism between the Light Adjustable Lens (LAL) from the Post Approval Study (PAS) and two contemporary toric intraocular lens (IOL) studies.

Setting: Six, fourteen, and twenty surgical sites across the United States.

Design: Randomized prospective case series.

Methods: The LAL patient population comprised 332 adults with pre-existing corneal astigmatism. Two contemporary astigmatic control datasets were selected for comparison. The first dataset included 111 eyes that received an aspheric toric monofocal AcrySof IQ IOL (SN6AT, Alcon, Inc.). The second dataset consisted of 101 eyes treated with an aspheric toric monofocal enVista IOL (MX60ET, Bausch & Lomb, Inc.) as part of ClinicalTrials.gov NCT05739656.

Results: For the LAL group, the Mean Absolute Error (MAE) of residual astigmatism was 0.26 ± 0.27 D, compared to 0.36 ± 0.35 D for the SN6AT group and 0.38 ± 0.38 D for the MX60ET group. The percentage of cases with residual astigmatism ≤ |0.50| D was 92.5% for LAL, 76.6% for SN6AT, and 76.2% for MX60ET. Spherical equivalent (SEQ) within ≤ |0.50| D was achieved in 93.1% of LAL cases, 83.8% of SN6AT cases, and 87.1% of MX60ET cases. Uncorrected Distance Visual Acuity (UDVA) was -0.02 (20/19) for LAL, 0.08 (20/24) for SN6AT, and 0.10 (20/25) for MX60ET.

Conclusions: Postoperative adjustment capability of the LAL enables significant reduction in residual astigmatism and SEQ, contributing to improved uncorrected distance visual acuity and enhanced patient satisfaction.

Purpose: To investigate genetic variants associated with the dysregulation of lens epithelial cell (LEC) homeostasis in patients diagnosed with Dead Bag Syndrome (DBS).

Setting: Cataract and IOL Research Centre.

Design: Laboratory study.

Methods: Genomic DNAs from 37 cases and 33 controls were subjected to whole-exome sequencing. Exome wide rare variants association by Chi-square test followed by gene wide cumulative rare variant burden analysis using optimal unified sequence kernel association test were performed. The effect size and the directionality of the genetic variants associated with DBS was assessed by logistic regression analysis.

Results: 12 genes showed a significant (P < 0.05) and positive (OR > 1.0) association with DBS, of which 9 (APC2, CD320, MSLN, TJP1, TNS1, TRPM5, USPL1, ZFHX3) were expressed in LECs, involving 3 key pathways crucial for LEC homeostasis. Notably, 97.3% (36/37) of cases, versus 54.5% (18/33) of controls, harboured at least one variant in these 9 genes. Additionally, 83.8% (31/37) of cases had variants in ≥2 genes compared to only 6.1% (2/33) of controls, suggesting an increased risk of DBS in those with multiple affected genes (OR = 80.1; 95% CI, 15.0-428.0; p < 0.0001).

Conclusions: Our study highlights a set of rare genetic variants affecting genes involved in RNA processing (GEMIN4, USPL1), epithelial integrity (TJP1, MSLN), and metabolic homeostasis (APC2, CD320, TNS1, TRPM5, ZFHX3) -three key pathways crucial for LEC homeostasis. It further supports a multigenic risk model and highlights the potential use of these genes as predictive markers for DBS manifestation.

Purpose: To examine the influence of eye movement variability on postoperative higher-order aberrations (HOAs), refractive and astigmatic changes after FemtoLASIK.

Setting: American University of Beirut Medical Center (AUBMC).

Design: Retrospective study.

Methods: A retrospective analysis was conducted on 94 eyes from 47 patients treated with the SCHWIND AMARIS system. Intraoperative eye-tracking data captured horizontal (X) and vertical (Y), and radial(R) positional shifts, with variability quantified using mean and standard deviation (STD). Correlations analyses examined the impact of movement fluctuations on postoperative corneal HOAs at 3 months, both unscaled and scaled by planned spherical equivalent (SEq) and astigmatism. Analyses were conducted on the full dataset and repeated using one eye per patient (right eyes only) after exclusion of high-influence points to eliminate pseudo-replication and assess robustness.

Results: Increased intraoperative fixation variability was associated with greater postoperative aberrations, with the strongest and most consistent correlations observed for spherical aberration (SA). Variability in horizontal, vertical, and radial eye position showed significant associations with induced SA, which were strengthened when positional measures were scaled by planned SEq. Several associations, particularly those involving SA, remained significant after removing high-influence points and were partially preserved in the one-eye sensitivity analysis.

Conclusion: Fixation instability (leading to movement variability) is consistently associated with increased induction of SA, and to a lesser extent, other higher-order aberrations following FemtoLASIK. Improvements in eye-tracking technology performance and fixation stability may reduce aberration induction and improve refractive outcomes.

Purpose: To evaluate the agreement of anterior segment biometric measurements between a new swept-source optical coherence tomography (SS-OCT) biometer (ZW-30) and a spectral-domain optical coherence tomography combined with Placido-disk topography (SD-OCT/Placido topographer, MS-39).

Setting: Eye and ENT Hospital of Fudan University, Shanghai, China.

Design: Prospective cross-sectional study.

Methods: This prospective, cross-sectional study recruited 70 healthy eyes from 70 participants. Each eye underwent three consecutive scans with both the ZW-30 and MS-39. Parameters analyzed included central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), mean keratometry (Km), J0, J45 astigmatism vector components and corneal diameter (CD). Inter-device differences were evaluated using paired t-tests, Bland-Altman analysis with 95% limits of agreement (LoA) assessed the agreement.

Results: Significant differences were observed in all parameters measured, except for J0. Bland-Altman analysis indicated high agreement for CCT (mean difference: 5.38 ± 3.67 μm; 95% LoA: -2.73 to 13.48 μm), ACD (-0.11 ± 0.03 mm; -0.18 to -0.03 mm), LT (-0.06 ± 0.05 mm; -0.17 to 0.05 mm), Km (0.07 ± 0.16 D; -0.33 to 0.47 D), J0 (0.02 ± 0.12 D; -0.31 to 0.27 D), J45 (-0.08 ± 0.09 D; -0.32 to 0.16 D). A larger discrepancy was observed for CD (0.48 ± 0.13 mm; 0.17 to 0.79 mm).

Conclusions: The ZW-30 SS-OCT biometer and the MS-39 SD-OCT/Placido topographer demonstrated high agreement for most anterior segment parameters, indicating their interchangeability in clinical practice. However, caution is advised when using CD measurements interchangeably due to the observed systematic differences between devices.

Purpose: To compare six-month visual and patient-reported outcomes between topography-guided (TG) using Contoura with Phorcides (Alcon) and wavefront-guided (WFG) LASIK using iDesign 2.0 (Johnson & Johnson) laser-assisted in-situ keratomileusis (LASIK).

Setting: Joint Warfighter Refractive Surgery Center, Lackland Air Force Base, TX, USA.

Design: Prospective, double-blinded, randomized.

Methods: Sixty-six subjects receive TG-LASIK in one eye and WFG-LASIK in the contralateral eye. Preoperative and postoperative assessments included uncorrected (UDVA) and corrected distance visual acuity (CDVA), manifest refraction, higher order aberrations (HOAs), Schirmer's test, and validated questionnaires (Patient-Reported Outcomes with LASIK - Symptoms and Satisfaction (PROWL-SS); Standard Patient Evaluation of Eye Dryness (SPEED)). Flaps were created with the Zeiss VisuMax femtosecond laser, followed by TG or WFG excimer laser ablation. Outcomes were evaluated at multiple time points through six months.

Results: At six months, 54% of WFG-LASIK eyes and 46% of TG-LASIK eyes achieved UDVA of 20/16 or better (P=0.48). TG-LASIK showed a higher efficiency index (1.08 vs. 1.02; P=0.03) and better mean spherical equivalent (SEQ) (0.04 D vs. 0.13 D; P=0.04), while WFG-LASIK had superior low-contrast (LC) UDVA and CDVA. Safety indices, residual HOAs, and dry eye symptoms were similar between groups. Both procedures significantly improved patient satisfaction and reduced visual disturbances compared with baseline.

Conclusions: Both TG-LASIK and WFG-LASIK using the latest excimer and diagnostic platforms, Contoura with Phorcides on the WaveLight EX500 and iDesign 2.0 on the VISX STAR S4 IR, are highly effective and safe options for customized refractive correction.

Purpose: To compare the refractive, visual, and higher-order aberration (HOA) outcomes between selective corneal wavefront-guided (CW) and aberration-free (AF) ablation profiles in eyes undergoing laser-assisted in situ keratomileusis (LASIK) using a high-repetition-rate excimer laser platform.

Setting: Hong Kong Sanatorium & Hospital, Hong Kong Special Administrative Region.

Design: Retrospective, contralateral eye study.

Methods: Patients who underwent myopic LASIK using the AMARIS 1050RS excimer laser with one eye treated with CW and the other with AF ablation profile were included. In the CW group, only vertical coma (Z[3,-1]), horizontal coma (Z[3,1]), and spherical aberration (SA) (Z[4,0]) that reached a clinically relevant level (≥0.25 defocus equivalent) were treated. Subgroup analysis was performed based on the HOA components involved.

Results: Eighty-five patients were included. Postoperative astigmatism and corrected distance visual acuity were comparable between the CW and AF groups overall and in all treatment subgroups (P>.05). The postoperative sphere was more hyperopic in the CW group than that in the AF group, with differences of 0.18 D overall and 0.26 D in the SA-treated subgroup (both P<.001). None of the eyes (0%) lost two or more lines. Postoperative root-mean-square HOA and individual HOA components generally showed less induction or greater reduction in the CW group than in the AF group.

Conclusions: LASIK with CW and AF ablation using the AMARIS 1050 RS excimer laser was safe and yielded satisfactory visual outcomes, with CW ablation inducing less or reducing more HOAs than AF ablation. SA treatment-related hyperopic shift was observed with CW ablation.